Maternal and Child Health in Nepal

The story of mother-to-be Lalita, who we see receiving quality prenatal care in the video above, is an increasingly common one in Nepal. Because the country has significantly improved access to maternal, newborn and child health services, young women like Lalita no longer have to worry about unsafe deliveries as their mothers did. That’s something Nepalis are proud of.An integrated package of interventions is helping the country reach its goal of ensuring that 60% of all deliveries are assisted by skilled birth attendants by 2015, and may offer lessons for other nations looking to accelerate their progress toward Millennium Development Goals 4 and 5, on maternal and child health.

Nepal’s approach includes community-based service delivery initiatives such as the recruitment of thousands of female health volunteers; integrated management of childhood illnesses; newborn and birth preparedness packages; and free essential health care services.

The Aama program -- introduced in 2007 to fully subsidize the cost and ensure mothers do not pay anything out of pocket for institutional deliveries – has helped to significantly increase the proportion of deliveries assisted by skilled birth attendants, from 19% in 2006 to 36% in 2011. The program works in tandem with a demand-side incentive to increase utilization of antenatal care and neonatal care services.

In 2010, Nepal was commended for its progress on achieving MDGs 4 and 5, and was identified as a country most likely to achieve its MDG 4 target. The numbers tell the story: Between 1993 and 2010, the estimated maternal mortality ratio in Nepal declined from 539 to 170 maternal deaths per 100,000 live births. Between 1996 and 2011, under-five mortality rate has declined from 118 to 54 per 100,000 live births.

The reasons for Nepal’s success -- in a politically unstable environment -- have been subject to much debate and probably include all the initiatives mentioned above, as well as significant improvements in education and poverty reduction, expansion of physical infrastructure, and reduction in total fertility rates. But equally important is the fact that Nepal has stayed the course, despite numerous leadership changes, with consistent support from its development partners, including IDA, the World Bank’s fund for the poorest.

Although commendable results have been achieved at the national level, not all segments of society have benefitted equally from the improvements recorded. For instance, the percentage of deliveries assisted by skilled birth attendants is 10.7% for the poorest and 81.5% for the richest quintile. Similarly, under-five mortality rate is 75 for the poorest quintile and 36 per 1000 live births for the richest quintile. In response the Ministry of Health and Population has elaborated a Gender and Social Inclusion Strategy and, as the next challenge, needs to show the same determination to implement it.

Against the backdrop of this week’s U.N. General Assembly meetings in New York, where leaders are meeting to discuss further progress toward MDGs 4 and 5, Nepal offers a positive case study of long-term, national commitment and an integrated approach to scaling up access to health services for women and children.